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September 2013 digital.OphthalmologyBusiness.org
Responsive website design P. 12 Issues in selling a subspecialty practice P. 24
Six tips to better
networking
outside the
ophthalmic box
P. 8
eZINETM
An ASCRS Publication
It’s not as difficultas it may appear.Info from an OWLwebinar will helpget you started.
Page 16
© 2013 Hearing Healthcare Management, Inc.
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May 2013 digital.OphthalmologyBusiness.org
Responsive website design P. 12 Issues in selling a subspecialty practice P. 12
Six Tips to better
networking
outside the
ophthalmic box
P. 8
eZINETM
An ASCRS Publication
It’s not as difficultas it may appear.This OWL webinarwill get you started.
Page 17
September 2013
Donald R. [email protected]
Julio GuerreroGraphic [email protected]
Stacy [email protected]
Jena [email protected]
Daniela GaleanoProduction [email protected]
Advertising SalesJeff [email protected]
Paul [email protected]
ASCRS Publisher: OPHTHALMOLOGY BUSINESS is
published quarterly by ASCRS Ophthalmic Services
Corp., 4000 Legato Road, Suite 700, Fairfax, VA
22033-4055; telephone 703-591-2220;
fax 703-591-0614. Printed in the U.S.
Editorial Offices: OPHTHALMOLOGY BUSINESS,
4000 Legato Road, Suite 700, Fairfax, VA 22033-4055;
703-591-2220; fax 703-591-0614;
email: [email protected]
Advertising Offices: ASCRSMedia,
4000 Legato Road, Suite 700, Fairfax, VA 22033-4055;
toll-free 800-451-1339, 703-591-2220;
fax 703-591-0614; email: [email protected]
Copyright 2013, ASCRS Ophthalmic Services Corp.,
4000 Legato Road, Suite 700, Fairfax, VA 22033-4055.
All rights reserved. No part of this publication may
be reproduced without written permission from the
publisher. Letters to the editor and other unsolicited
material are assumed intended for publication and are
subject to editorial review and acceptance.
September 2013 • Ophthalmology Business eZine 5
www.OphthalmologyBusiness.org Vol. 3, No. 3
From the publisher
This issue of Ophthalmology Business eZine provides a variety of useful
information for ophthalmologists, including why you should consider net-
working with local businesses, how to use social media to market your prac-
tice, and how patients can become effective ambassadors for your practice.
In “Networking outside the ophthalmic box,” contributing writer
Vanessa Caceres presents six tips to help you decide how much your practice
needs to network outside of the medical community.
“Responsive” website design makes it possible to produce a site that the
largest number of potential customers will be able to access. In “The www of
responsive website design,” Brendan Gallagher and William B. Rabourn Jr.
explain what exactly responsive website design is and why it is important for
your practice.
Just as we’ve started to get a handle on traditional marketing platforms,
social media marketing platforms such as Facebook, Twitter, LinkedIn, and
Instagram are gaining visibility and credibility. Tammy Evans, MS, and Laura
Wyant discuss the benefits, drawbacks, and ways to use these social media
marketing platforms in your practice.
Visual outcomes beyond 20/20 in LASIK surgery can affect the likeli-
hood a patient will refer a family member or friend to your practice. Steve
Schallhorn, MD, shares the details of a study he and colleagues conducted
in “The science of patient referrals.” “What’s interesting is that [patients]
were even more likely to refer if they achieve 20/16 uncorrected vision,
meaning that achieving the best uncorrected vision possible helps drive
referrals,” Dr. Schallhorn said.
We hope you find this information helpful and can put it to good use in
your practice. Thank you for reading!
Don Long
Publisher
Contents
Page 8 Networking outside the ophthalmic box
Page 14 Good business decisions for doctors
Page 24 Issues in selling a subspecialty practice
Page 12 The www of responsive website design
6 Ophthalmology Business eZine • September 2013
5 From the publisher
8 Networking outside the ophthalmic boxWhen and why to consider networking with local businessesby Vanessa Caceres
12 The www of responsive website designWhat it is, why is it important, and why the time is nowby Brendan Gallagher and William B. Rabourn Jr.
14 Why business people think doctors are stupidHow did doctors earn the reputation of being bad at making
business decisions, particularly in the area of money
and finance? by Mitch Levin, MD, CWPP, CAPP
16 The OWL webinar: Marketing your business
and products with social mediaThe key to effective social media is to ensure that you choose
the ones that are right for your business and then leverage
their marketing potential to the fullestby Tammy Evans, MS, and Laura Wyant
20 The science of patient referralsHow patients can become effective ambassadors
for your practiceby Ophthalmology Business Staff Writer
24 Issues in selling a subspecialty practiceThe uniqueness of a subspecialty practice may require that a
seller be open and flexible on the terms of a sale by Brad Ruden, MBA
8 Ophthalmology Business eZine • September 2013
by Vanessa Caceres Contributing Writer
Networkingoutside the ophthalmic box
When and why to consider networkingwith local businesses
September 2013 • Ophthalmology Business eZine 9
There’s no question that
ophthalmologists are
busier than ever nowa-
days. “In the present
environment, everyone is
spinning as fast as they can,” said
John B. Pinto, president, J. Pinto &
Associates, San Diego.
You probably get a good deal of
business from word of mouth or
referrals from other doctors. In addi-
tion, you probably have a busy fami-
ly life to balance with work obliga-
tions. “Most of us have families and
tend to hurry home or get the kids
after work,” said Sandra Yeh, MD,
Springfield, Ill.
It’s common for ophthalmolo-
gists to network with other ophthal-
mologists and optometrists. How-
ever, if your practice and family life
are already operating at full tilt, why
6 tips to better
outside networking
Know your market. In a small town or if you’re at a new practice, net-
working outside of the medical or ophthalmic community can help
grow your business, Mr. Pinto said. In a large, competitive market—such
as Dallas or Los Angeles—shaking hands at the Thursday Rotary Club lunch
may not be as important. It’s also a slow way to build relationships, he added.
Mr. Pinto believes that networking with optometrists is the most effective
practice-building move for ophthalmologists, although he added that outside
networking has its place for a number of practices, especially those located in
the suburban and rural markets.
Plan and prioritize where you will network. If you decide to invest
in networking outside of the medical community, you’ll probably
find you have many options. “The struggle is there are so many
groups to choose from, we could have a full-time position for someone to
should you consider networking at
nonmedical meetings?
Depending on your market,
nonmedical networking meetings
could be a way to grow your busi-
ness, keep your practice’s name in
the community, and get leads not
only for patients but also for other
connections your practice needs.
Some nonmedical networking
you may want to consider (if you
haven’t already) includes the local
chamber of commerce, free and paid
local business organizations, frater-
nal groups such as Kiwanis and
Rotary, and charitable/nonprofit
groups.
Here are some tips to help you
decide how much your practice
needs to network outside of the
medical community.
1
2continued on page 10
10 Ophthalmology Business eZine • September 2013
attend them,” said John Swencki,
CEO, The Eye Associates, Sarasota,
Fla.
Your best approach is to meet
with the other physicians and key
managers to plan which groups
might give you the best bang for
your buck—and who should attend
the various meetings. “You don’t
want to make that decision in a
vacuum,” said Mr. Pinto.
At The Eye Associates, eight
senior managers have commitments
with different business groups and
nonprofits, said Mr. Swencki. “The
doctors are brought in more for
speaking engagements,” he said.
As you meet with staff, you
might decide that your administrator
will attend the monthly chamber
functions, the founding physician
of the practice will continue to
go to Rotary meetings, and the
optometrist will shake hands regular-
ly at the Kiwanis Club.
Think about who on
your staff will benefit
from outside networking.
Mr. Pinto often advises younger oph-
thalmologists to network so they get
experience with public speaking and
to learn how to deal with the “every-
day Joe.” Public speaking experience
has been one benefit that Adam J.
Clarin, OD, Miami, received from
joining Business Networking
International (BNI), an international
networking organization. Members
pay several hundred dollars to join
BNI but usually receive better quali-
fied referrals than they would else-
where. Weekly meetings include a
short presentation from members;
members attend training to learn
how to network and give better pre-
sentations. “I tried other networking
groups but was shy,” said Dr. Clarin.
“BNI taught me how to stand in
front of a group and present.”
If you have a new physician at
your practice, that person may the
ideal choice to attend some local
networking meetings for good PR.
Consider synergies.
The Eye Associates gives
financial support and vol-
unteer and networking time to the
nonprofit groups Senior Friendship
Center and Southeastern Guide
Dogs. The latter organization trains
guide dogs to work with the visually
impaired. The organization has a
natural connection to vision issues—
plus, it’s easier to pick one or two
groups to focus on, said Mr. Swencki.
“If we didn’t pick one,
we’d be going in many different
directions,” he said.
Evaluate ancillary benefits.
Not all of your networking
opportunities will be
extremely (or immediately) prof-
itable, but are there other benefits
you can get from belonging? At one
local group, a commercial realtor
provided The Eye Associates with a
lead for a new location. Attending
business lunches may give you leads
for new and qualified staff. Dr.
Clarin said he is able to easily access
advice from local professionals
thanks to his BNI colleagues. “I can’t
put a price tag on knowing I can get
a lawyer on the phone quickly and
it won’t cost me anything. I have a
network of professionals at my fin-
gertips,” he said.
Re-evaluate the bottom-
line benefit of your
networking annually,
Mr. Pinto recommended. “If you join
a local chamber or Lions Club and
there are 50 to 75 people in the
room, it only takes a couple of meet-
ings to drain the well dry,” he said.
So you may decide to belong to a
certain group for a year or two and
then try another opportunity.
Dr. Clarin’s BNI membership has
yielded the practice $25,000 in rev-
enue over four years. “It’s definitely
been profitable,” he said. Plus, he’s
able to put a fun spin on saying that
a good referral for his practice is
“anyone with eyeballs.” At the same
time, he’s had to make a commit-
ment to attend weekly meetings and
training sessions.
Make a point with your staff
leaders every year to analyze what
financial and intangible benefits
your practice gets from each group
membership, Mr. Pinto said. Decide
if you need to scale back or expand
your nonmedical networking accord-
ingly.
“Any practice has limited
marketing resources, and you can’t
invest in everything out there. You
want the best return on your out-
reach investment,” he said. OB
Contact information
Clarin: 305-253-2525,
Pinto: 619-223-2233, [email protected]
Swencki: 941-792-2020,
Yeh: 217-698-3030, [email protected]
3
4
5
6
continued from page 9
12 Ophthalmology Business eZine • September 2013
by Brendan Gallagher and William B. Rabourn Jr.
The www of
responsivewebsite design
Website technology has
evolved over the
years, but none of the
many changes has
been more momen-
tous than the explosion of mobility
and the ubiquitous rise of internet
access via a wide variety of mobile
devices. We don’t have a silver bullet
for reaching all customers on all
devices; however, current web tech-
nology and what we call “respon-
sive” website design makes it possi-
ble to produce a site that the largest
number of potential customers will
be able to access.
What is responsivewebsite design?
Responsive website design encom-
passes many different technologies,
development processes, and web
design techniques. In a nutshell,
responsive websites make it possible
for a single set of content and design
What it is,why is itimportant,and whythe timeis now
elements to be used across a broad
spectrum of devices and screen sizes,
giving more users a positive mobile
website experience, enforcing brand-
ing, and maintaining look and feel
regardless of the web users’ screen
size or device. Ultimately, as with all
quality websites, a responsive web-
site design engages users and encour-
ages interaction with the content on
their own terms with the device of
their choice.
Why is it important?
We want more. More web users are
on more mobile internet-enabled
devices more than ever before.
Average monthly smartphone usage
grew 81% in 2012. The number of
mobile-connected devices will
exceed the world’s population this
year, and the Cisco VNI Mobile
Forecast for 2013 predicts continued
growth. A 2012 Google survey
conducted by independent market
research firms Sterling Research and
SmithGeiger reported that 74% of
respondents are more likely to return
to a mobile website in the future if it
is built in a mobile-friendly way, and
67% of mobile users say that they
are more likely to buy a product or
service when the site is mobile-
friendly. The need for mobile
websites cannot be understated.
More web users are becoming
multiscreen oriented, using a combi-
nation of TV, laptop, tablet, and
smartphones sequentially or simulta-
neously. Another Google 2012
survey (Ipsos/Sterling) found that
90% of our daily media consumption
revolves around interaction with
various screens. An estimated 38% of
our daily media interactions take
place on smartphones, and 77% of
TV viewers are using a smartphone
or other device while watching pro-
grams. These findings have wide
implications as to how we reach
potential customers. And don’t think
that these statistics apply only to the
younger end of the age spectrum.
According to the Nielsen Connected
Devices Study (Q2/2012), 36% of
people age 35–54 and 44% of 55- to
64-year-old respondents use their
tablets while watching TV. These
trends point to the need to reach
consumers in the way they are con-
suming media by adopting multi-
screen marketing campaigns that
optimize and coordinate mobile
efforts. Optimizing your website to
accommodate the changing land-
scape should be a part of any ongo-
ing marketing or education.
In the past, a popular solution to
the mobile website problem has been
to create a mobile-specific website
that directs users on a mobile device
or particular screen size to a com-
pletely separate mobile optimized
website. Unfortunately, this method
greatly complicates website mainte-
nance and give rise to a number of
issues that must be addressed.
Mobile device users often find them-
selves directed to the full version of
the website and a less-than-satisfac-
tory experience. In other cases, the
mobile website duplicates existing
web content that must be main-
tained separately from the full web-
site. Duplicated content can nega-
tively impact search engine opti-
mization (SEO) efforts. A responsive
website resolves these issues by pro-
viding a single set of content and
maintaining a similar complementa-
ry look and feel. Search engine opti-
mization, an important component
of any modern website, benefits
from the use of a single set of con-
tent. When the content of a page on
your “full” website and the content
of the page on the mobile site are
the same, analytics yield a much
clearer picture of usage and interac-
tion with the site, regardless of the
device used to access it and screen
size.
Why is NOW the time?
Timing can make the difference
between success and failure. The
term “responsive design” has been
around since 2010, and the social
media outlet Mashable has declared
2013 as the year of responsive web
design. Even so, responsive websites
have not been widely adopted.
The primary factor in slowing
the large-scale adoption of respon-
sive design revolved around available
technology and usability across the
most common platforms and web
browsing software. Newer technolo-
gy makes this less of an issue.
Developers have created frameworks
and systems around these new ways
of design and thinking. Another
good indication that a specific tech-
nology has “arrived” is its adoption
by major vendors for their own web-
sites. Within the past year, Sony,
Starbucks, and Microsoft have all
adopted responsive websites for their
online presence.
Responsive websites are not the
only answer to the number of issues
emerging in website mobility and
design. Technology will continue to
evolve and change. At this point in
time, responsive website design tech-
nology represents an important tool
for meeting mobile goals, creating
positive user experience, and reach-
ing customers across the growing sea
of internet-enabled devices. OB
September 2013 • Ophthalmology Business eZine 13
Mr. Gallagher is an
information technology &
web services consultant
at Medical Consulting
Group, Springfield, Mo.
He can be contacted at
Mr. Rabourn is the
founder and managing
principal of Medical
Consulting Group,
Springfield, Mo. He is a
member of ASOA. He
can be contacted at [email protected].
14 Ophthalmology Business eZine • September 2013
by Mitch Levin, MD, CWPP, CAPP
Why business people think
doctors are stupid
Doctors arenot stupid. On the contrary, you are well
educated and often brilliant. You
are trained in pattern recognition,
absorbing and systematically analyz-
ing tremendous amounts of data to
arrive at a diagnosis and develop a
treatment plan most wholly appro-
priate for your patient.
You are held to an extremely
high standard, not only in terms of
work ethic, but also in terms of ethi-
cal treatment of your patients. How
then did doctors earn the reputation
of being bad at making business
decisions, particularly in the area of
money and finance?
First, there are huge pressures
on your net income. You have little
time to manage your practice or
even your personal life. You have a
multitude of challenges associated
with managing a busy medical prac-
tice. Uncontrollable outside forces
affect your revenue stream and
expenses, as well as perceived man-
dates and risks—whether real or
imagined.
Although this may be the best
time in history to be a physician,
given the opportunities to provide
care, cure, and comfort to patients,
many physicians are not happy with
the practice of medicine. Their dis-
satisfaction often leads to financial
“overreach” in an effort to compen-
sate.
Second, when it comes to
money and finance, physicians try to
identify patterns, as you have been
trained to do in your own medical
field. But of course, investments and
markets offer no more patterns than
does reading tea leaves.
Third, doctors often have mis-
placed trust. You may expect your
financial advisor to have a compara-
ble educational level and the same
level of ethics associated with the
Hippocratic Oath. Unfortunately,
most other professions do not have
our rigorous education, and in every
profession, there are individuals who
fall well short ethically.
The following examples illus-
trate bad advice often given to physi-
cians. For asset protection, you may
have been ill advised to buy the
biggest house that you could afford.
This can lead to an upside-down
cash flow situation. Likewise, you are
often told to maximize your pre-tax
contribution to a qualified plan,
which, if you are successful, could
lead to paying higher taxes later.
In addition, you are often told
that building equity is extremely
important, yet equity earns zero. All
too often you wind up “cash poor”
and in a non-liquid investment com-
plicated by discontent among busi-
ness partners, particularly if the real
estate is not valued at market rates.
This problem is compounded when the real estate is
owned by a few, while the lease payments are paid by
many.
Fourth, you are bombarded with all kinds of popular
financial media data points that are often inaccurate.
Much of this information is inconsistent, most of it writ-
ten by journalists and not by financial experts, thus
many are misled by this dysfunctional financial enter-
tainment. Financial journalists are often dependent upon
certain resources that may have a conflict of interest,
such as a brokerage house.
With all of this available public “information” and
the intelligence and work ethic that you have, plus your
ability to take in, interpret, and analyze data, it’s no
wonder you may feel that it may be easy to “do it your-
self.” In essence, you are assuming the role of someone
who, as a highly qualified professional, has devoted
his/her professional life to it (as you have with your
expertise). You were too busy before that decision! When
the task becomes too complicated, you are left to identi-
fy a truly trustworthy financial advisor.
Fifth, this leads to more discontent and the cycle
perpetuates itself.
Sixth, mistakes in business, investing, and financial
matters are frequently masked by your high cash flow.
These mistakes are encouraged by media, some advisors,
and by the physician’s own perceptions. Sadly, the medi-
an U.S. household income is $70,000, and only 3% of
the American population is able to retire on that $70,000
a year. The physician’s median household income is
closer to $300,000, yet only 4% of physicians are able to
retire on that amount.
Ultimately, how can you dispel the “doctors are not
good at business” myth? The solution is simple. Select a
proven, fee-based professional who is a well-educated
financial expert to consult you, without obligation, to
help you define where you are, where you want to be,
and what it will take to get there.
With their help, should you choose to accept it, you
will get a tailored plan to take you from today to goal
achievement. They will outline your opportunities, pro-
tect your assets, lower your taxes, fortify your cash flow,
bolster your performance, and, perhaps more important-
ly, ease your path to a worry-free retirement. You have
the intelligence, the discipline, the capacity, and wealth
—now take the step, follow the plan, and make great
decisions. OB
Dr. Levin is CEO and managing direc-
tor of Summit Wealth Partners,
Orlando, Fla. He can be contacted at
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16 Ophthalmology Business eZine • September 2013
It’s a brave new (marketing)
world. In addition to tradition-
al marketing platforms such as
radio, TV, print, and word-of
mouth-referrals, we also have
internet marketing platforms, includ-
ing website marketing, pay per click
ads, and for ophthalmic practices,
directories. Just as we’ve started to
get a handle on those, social media
marketing platforms such as
Facebook, Twitter, LinkedIn, and
Instagram have started to gain
visibility and credibility. What’s a
business to do?
First, one must recognize that
it’s not solely about the technology.
Though social media platforms (or
“channels”) have certainly gained a
foothold, the only thing that sepa-
rates them from older mediums is
their social nature. Yes, in some cases
marketing information must be pre-
sented in a different manner than
we’re accustomed to (Twitter’s maxi-
mum of 140 characters comes to
mind), but traditional marketing
objectives and goals are still in
force—namely, branding, product
promotion, word-of-mouth referral
support, attracting and acquiring
new clients, and client retention.
All marketing platforms, includ-
ing social media, are utilized for one
reason: to market your business. As
with traditional marketing mediums,
the key to effective social media is to
ensure that you choose the ones that
are right for your business and then
leverage their marketing potential to
the fullest, integrating them with
your traditional marketing to
promote your business brand.
It’s not as difficult as it may
appear. Here’s how it’s done.
Getting started
What is social media good for?
For one, it allows a company or
organization to engage its clients
(and potential clients) with perceived
value-added features, the purpose
of which is ultimately to facilitate
brand and/or product loyalty. For
example, if you are attending an
Ophthalmic Women Leaders (OWL)
event, it is likely you will be encour-
aged to “like” the organization’s
Facebook page for industry updates
and news, as well as follow it on
LinkedIn for additional professional
news.
More recently, people have been
using social media in lieu of tradi-
tional business cards (LinkedIn) and
to connect (Facebook and Twitter).
At the very least, people exchange
Twitter handles at social gatherings
to connect immediately and then
follow up from that channel.
For professionals, a LinkedIn
Group is a good way to hold discus-
sions and be part of a larger whole.
OWL’s LinkedIn Group page, for
example, provides followers with
highlights on the latest Ophthalmic
Woman Magazine as well as referrals
and processes, industry gathering
news, and more. In other words,
social media is a great way for a
company or organization to provide
more than what is offered on its
website.
To understand which social
media channels will work best for
your company’s needs, let’s look at
the benefits and drawbacks of four of
the most important channels—
Facebook, Twitter, LinkedIn, and
Instagram—and discuss how you
could (and should) use them.
Facebook (1.15 billion users)
Think of Facebook as: A place for
the 3 Cs: content, copy, and connec-
tions.
Benefits: Most popular social
network; easily accessible; low-cost
marketing strategy; ability to reach
essentially everyone else who is on
Facebook (as of June 2013, there
were 1.1 billion users); analytics help
determine important demographic
information about your fans so you
can develop a targeted strategy.
Drawbacks: Potential to get lost
in the crowd; sharing of information
September 2013 • Ophthalmology Business eZine 17
by Tammy Evans, MS, and Laura Wyant
The OWL webinar:
Marketing yourbusiness and products with social media
continued on page 18
18 Ophthalmology Business eZine • September 2013
must remain aligned with business
plan and desired presence/target
audience; legal may require preau-
thorization of content, so planning
is essential; planning is also impor-
tant for optimal engagement and
continuity, but planning too far in
advance makes it difficult to remain
new and relevant.
How to use it: A Facebook page
is not just something to create and
then forget about. You need to be
committed. Post regular updates to
your fans and provide useful con-
tent. You need to participate in the
conversation—share images and
become immersed in Facebook to
provide an excellent social media
service that represents your company
as a reputable organization.
Facebook is a great landing spot
to begin the chain link of social
media you want for your company,
practice, or organization. It is a great
place to engage consumers—not
with technical information, but
rather with information that is enter-
taining while still containing details
about your brand.
From Facebook, you can tie in
LinkedIn posts, Instagram pictures,
Tweets, and company website traffic
to boost your visibility and round
out your social media presence for
maximum exposure and engage-
ment.
Twitter (500 million users)
Think of Twitter as: A “micro-blog.”
Benefits: Access to celebrities,
individuals, medical practices,
institutions, and industry experts;
real-time sharing of information,
advancements, and updates; concise
messaging; immediate ability to con-
duct damage control; hashtagging
quickly categorizes conversations
and events. All of this is contingent
on engagement, meaning a conversa-
tion you can participate in is always
happening.
Drawbacks: Contingent on
engagement (both a positive and a
negative); closer monitoring required
than Facebook; active presence
requires expert and professional
content creation and monitoring.
How to use it: A company
Twitter account is recommended to
link to industry information, speak-
ing events and trends, while incor-
porating the use of hashtags to
organize and filter Tweets. This
allows you to carve out niche follow-
ers, provide them with updates and
lead them to Facebook, LinkedIn,
as well as your company website.
Twitter can also be used to connect
to sports teams, companies, and
Twitter accounts focusing on tech-
nology and innovation.
Twitter should be used to talk
about company happenings to posi-
tion your business as an interesting,
“living” entity. This can range from
product release announcements to
industry recognition you receive.
Twitter posts are a good way to lead
people to your website or other
social media channels where addi-
tional information is available.
Twitter can also be used to link to
other industry happenings in order
to make it clear to your target
Twitter audience that following you
keeps them in the loop on industry
happenings, not just your company.
By appearing to be in the know, you
enhance your brand.
LinkedIn (225 million users)Think of LinkedIn as: Professional
social media for companies and indi-
viduals.
Benefits: Making professional
connections; developing advanta-
geous partnerships; following com-
panies and industry best practices;
ability to create practice or company
pages to improve SEO and visibility
online; networking opportunities;
speaking engagements (participation
or attendance); SEO improvement.
Drawbacks: Individual/personal
LinkedIn accounts are not always
kept up to date by busy profession-
als, so you may be connecting with
people who have outdated informa-
tion (current titles, employment
information); unless you’re a social
media professional, it may be confus-
ing to decipher between Group and
Company pages; works best for busi-
ness-to-business.
How to use it: LinkedIn estab-
lishes you on a professional level.
Unlike most social media channels,
continued from page 17
Ms. Evans is vice
president of marketing at
Ceatus Media Group, San
Diego. An OWL member
since 2008, she is the
current programs
committee chair. She can be contacted
Ms. Wyant is the
manager of
Digital Media
at Pascale
Communications.
She can be contacted
it exists solely for professional pur-
poses. To this end, there are two
important types of professional
LinkedIn pages: Group pages and
Company pages.
Company page: A basic Company
page on LinkedIn often includes
information gleaned from the com-
pany website. Establishing presence
on LinkedIn lends credibility and
improves SEO, and lends visibility to
a company, practice, brand, or
organization. From here companies
or practices post news, company and
industry updates, photos, speaking
opportunities, and more.
Group page: After a Company
page has been set up, some (if not
most) organizations wish to hold dis-
cussions. A Group page on LinkedIn
is a secondary account where discus-
sions are held between Group mem-
bers and managers of the Group. The
benefit of a Group is to have a con-
stantly evolving and updated space
for conversations without having to
inundate the Company page with
information.
Instagram (130 million users)
Think of Instagram as: A visual
channel to tell your story.
Benefits: Visual platform for
reaching your target audience; for
those in the healthcare industry,
presence can potentially benefit
from a refreshing visual makeover
(highlight services, practice, proce-
dures unique to your practice; per-
sonalize doctors; etc.); linking to
community will help build a follow-
ing and a network; lets followers see
behind the “curtain” of your busi-
ness; great for contests and participa-
tion.
Drawbacks: Instagram easily
becomes stale; overly used hashtags
cause content to become lost in the
sea of photos; inappropriate channel
for some businesses and practices;
visual and copy must reflect compa-
ny/practice culture and message.
How to use it: Instagram is a
visual tool that employs hashtags
and themes to propel an organiza-
tion into the visible sphere of social
media. We can use Instagram to tell
a story in pictures. What would a
picture book of your practice or mes-
sage look like? Creating an Instagram
account around this idea is challeng-
ing, but for certain companies and
practices it allows for a unique per-
spective. A visual representation of a
company or an organization is not a
fit for everyone, and Instagram is not
the platform of choice for delivering
a company message. However, it can
be a good supplement to your social
media campaign, highlighting the
behind-the-scenes perspective and
lending character and personality to
your company. Also, it is important
to note that Instagram is currently
even more popular than Twitter.
How long this trend lasts remains to
be seen.
Tying it all together
Launching a social media campaign
is fairly straightforward; Facebook,
Twitter, LinkedIn, and Instagram link
to your company or practice website
via buttons (speak with your website
developer—it’s an easy process to
implement). Ideally, all of your social
media channels will feed into a con-
stantly churning cycle of informa-
tion that helps maintain top-of-mind
presence for anyone searching for
additional information about your
company or practice, expanding
your footprint and ultimately
improving your search engine rank-
ings. However, this does not mean
that every business should invest
time and money into every social
media channel. Boil down your goals
and ask yourself: Which channels
will work best for my business? OB
September 2013 • Ophthalmology Business eZine 19
20 Ophthalmology Business eZine • September 2013
The science of
patient referrals
September 2013 • Ophthalmology Business eZine 21
by Ophthalmology Business Staff Writer
How patients can
become effective
ambassadors for
your practice
Visual outcomes beyond
20/20 in LASIK surgery
can affect the likelihood a
patient will refer a family
member or friend to your
practice, according to a study by
Steve Schallhorn, MD, global
medical director, Optical Express,
Glasgow, U.K., and colleagues that
looked at a large dataset from the
Optical Express Ambassador Referral
Program, which was launched in
2010.
Through the referral program,
patients have the opportunity to
refer a family member or friend, Dr.
Schallhorn said.
The program allowed Dr.
Schallhorn and colleagues to track
patients who referred another
patient.
“We looked at the characteristics
of those patients who referred anoth-
er patient, but only analyzed those
referrals that resulted in a procedure
being performed in the referred
patient,” he said.
In other words, a patient could
refer a friend but that friend might
have keratoconus and not be a good
candidate or elects not to undergo
surgery for whatever reason.
“Typically, this would be consid-
ered a referral, but it’s not the way
we defined a referral in this analy-
sis,” Dr. Schallhorn said.
He and colleagues compared the
demographics, pre-treatment, and
post-treatment characteristics of
patients who were ambassadors—
they referred another patient and
that patient got treated—with those
of patients who did not make any
referrals.
Dr. Schallhorn found that there
was a higher likelihood of patients
referring another patient if they had
certain characteristics; one of those
characteristics is better uncorrected
vision. If they achieved 20/20 uncor-
rected visual acuity, they were more
likely to refer than those who did
not attain 20/20, he said.
“What’s interesting is that they
were even more likely to refer if they
achieve 20/16 uncorrected vision,
meaning that achieving the best
uncorrected vision possible helps
drive referrals,” Dr. Schallhorn said.
“In hindsight this seems obvious
and should not have been unexpect-
ed—that the better the uncorrected
vision, the more likely patients
would refer. But prior to this, we
could never apply evidence-based
methods to analyze the science of
patient referrals because it requires a
huge, accurate, and meticulous
dataset. Now with the Optical
Express data we can do the analysis,”
he said.
Dr. Schallhorn looked at one
year’s worth of ambassadors, and the
data set was enormous. They had
about 18,000 patients who referred
another patient and compared those
18,000 to tens of thousands that did
not make any referral.
continued on page 22
22 Ophthalmology Business eZine • September 2013
Because there are more referrals
with better uncorrected vision, Dr.
Schallhorn said he and colleagues
have redoubled their efforts to try to
provide the best uncorrected vision,
and that means not stopping vision
testing at 20/20.
“We have to measure patients
postop to determine out how we can
further improve our surgery,” he
said.
“One important goal of laser eye
surgery should be to provide patients
their best achievable uncorrected
vision,” he added.
Another thing Dr. Schallhorn
and colleagues found was that what
patients thought of the surgeon and
the care provided by the surgeon
were related to referrals. So if
patients thought very highly of the
care and skill of the surgeon and
his/her ability to communicate, they
were more likely to refer, he said.
“That has placed added empha-
sis on the quality of our interaction
with patients,” Dr. Schallhorn
explained.
The study’s findings add weight
to the concept of continuous quality
improvement, he said. In fact, the
evidence has helped all the staff to
get on board with aiming for better
than 20/20 vision.
In order to pursue this, Dr.
Schallhorn recommended that prac-
tices track their outcomes and per-
form an analysis to provide optimal
treatments. There are commercially
available software packages that can
help. Alternatively, utilize an estab-
lished nomogram and follow proven
techniques based on the practice
equipment to improve outcomes.
Finally, Dr. Schallhorn urged clini-
cians to push all patients to their
best vision and “do not stop at
20/20.” OB
Editors’ note: Dr. Schallhorn has
financial interests with Abbott Medical
Optics (Santa Ana, Calif.) and Optical
Express.
Contact information
Schallhorn: 619-920-9031,
continued from page 21
The better the postoperative uncorrected acuity, the greater the likelihood that a patient
will refer a friend or family member.
Source: Steve Schallhorn, MD
Send us your
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name and how it helped you.
Apps selected will be published in
Ophthalmology Business and their
submitters will receive a $50 iTunes
card. You may be selected for a brief
interview.
24 Ophthalmology Business eZine • September 2013
by Brad Ruden, MBA
Issues in selling a
subspecialty practice
Selling an ophthalmology
practice can be a daunting
task. It can be even more
difficult if the practice has
a dominant subspecialty
focus. The obvious practices with a
subspecialty focus are cornea, glauco-
ma, plastics, retina, or refractive
surgery. However, a cataract practice
that is wholly or substantially
dependent on OD referrals can also
be considered a subspecialty practice.
Market comps
The first hurdle is to identify a value
for the practice. The major business
transaction databases, such as Pratt’s
Stats, IBA Market Database, or
BizComps, are inadequate in that
they have very few ophthalmology
practice comps. At this time, the best
database for practice comps in oph-
thalmology is the Goodwill Registry.
While the Goodwill Registry
provides some terrific market comp
data, the downside is that it doesn’t
break down its transactions by oph-
thalmic specialty, except for vitreo-
retinal. Because of this, one doesn’t
know if the practices identified
are general ophthalmology or are
oriented to a particular subspecialty.
Frankly, over my 23 years consulting
in ophthalmology, I have yet to
come across a reliable database for
subspecialty ophthalmology practice
sales.
While the value of tangible
assets as well as office and medical
supplies can typically be identified
without market comps, the issue is
how to identify goodwill value.
Without proper market comps as a
guide for goodwill, a valuator will
usually rely on cash flow and earn-
ings to identify goodwill value.
Goodwill
The biggest issue with goodwill in a
subspecialty practice is: How much
of the goodwill value is institutional
(known as enterprise goodwill) and
how much is individual (professional
goodwill)? Enterprise goodwill is the
intangible value of the business that
can be transferred with a sale.
Professional goodwill is the intangi-
ble value that leaves with the selling
doctor.
In a refractive surgery practice, if
it has been marketed under an insti-
tutional name rather than a doctor’s
individual name—and it has a mar-
keting plan, patient education/con-
version plan in place—one could
argue for some institutional value.
However, most subspecialty practices
don’t rely on marketing and instead
rely on a referral network. Typically,
doctors refer to a practice because of
their confidence in the medical and
surgical skills of the subspecialist.
Because of this, one cannot guaran-
tee a referring doctor’s continued
patient referrals to a purchasing doc-
tor. This lack of transferability with a
referral base typically means a pur-
chasing doctor will offer less up
front for goodwill and may require
the majority of goodwill be paid on
a post-sale performance basis.
One can better ensure continued
referrals if the seller (a) continues to
work in the practice after the sale,
and (b) spends a fair amount of time
introducing the new practice owner
to the referral base. This can be done
with lunch meetings, dinner meet-
ings, casual get-togethers, or contin-
uing education seminars.
Table 1 isn’t intended to be all-
inclusive, but merely to provide a
guide as to the difference in building
goodwill.
Outright sale or partnership transition
Because of the issues previously stat-
ed, a subspecialty practice has two
options when it comes to a sale:
• Sell the practice outright but
base some (or a majority) of
goodwill on the practice’s post-
sale performance.
• Bring an associate on and sell
him/her shares of the practice over
time (a partnership transition).
The biggest concern in basing
goodwill on post-sale performance is
that despite all the due diligence
possible, one can never know if the
purchasing doctor can keep together
the referral base of the practice as it
goes beyond medical/surgical skills
and can be dependent on the inter-
personal relationship between the
doctors, how the patients feel after
being seen by the specialist, and the
business skills of the new owner.
The issues in a partnership tran-
sition are that (1) one must cannibal-
ize his/her own practice to feed vol-
ume to the new associate until that
person can build referrals on his/her
own, and (2) while all precautions
can be taken and the proper paper-
work utilized, there are no guaran-
tees an associate will go through
with the transaction. The advantage
of a partnership transition is that
when the transaction occurs it will
be a stock deal, which presently car-
ries a substantially lower tax burden
than an asset deal.
Summary
I hope the subspecialists reading this
article are not discouraged by what I
have written. The purpose of the
article is to create realistic expecta-
tions of what to expect when con-
templating the sale of a subspecialty
practice. In most cases, a practice
with a solid history of performance
and profitability can find a buyer.
However, the uniqueness of a sub-
specialty practice may require that a
seller be open and flexible on the
terms of a sale. OB
September 2013 • Ophthalmology Business eZine 25
Argument for personal goodwill
Argument for enterprise goodwill
Advertising/branding
The doctor’s name, reputa-tion, and experience arepromoted. Often a doctor’spicture is used in advertis-ing.
The business’ name andreputation are promoted.The practice may have alogo instead of a doctor’spicture in its advertising.
Patients
Patients come to the practice because of theirrelationship with the doctorand want to be seen by aspecific doctor.
Patients come to the practice
to be seen by any doctor.
Convenient location and sched-
ule availability play a role in
patients choosing the practice.
Patient referralsPatients come of their own choosing to see theirpreferred doctor.
Patients come of their ownchoosing—or are referred tothe practice by anotherprovider—to be seen by anydoctor on the staff.
ProvidersOne or two doctors, withtheir own specific patient following and referral base
Multiple doctors who seetheir own patients as well aspatients of other groupproviders when necessary
Mr. Ruden is a certified
valuation analyst,
MedPro Consulting &
Marketing Services,
Scottsdale, Ariz. He can
be contacted at 602-
274-1668 or [email protected].
Table 1
New Orleans 2013
This activity has been approved for
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